Survival of stroke patients after introduction of the ‘Dutch Transmural Protocol TIA/CVA’

Abstract

BackgroundEarlier research showed that healthcare in stroke could be better organized, aiming for improved survival and less comorbidity. Therefore, in 2004 the Dutch College of General Practitioners (NHG) and the Dutch Association of Neurology (NVN) introduced the ‘Dutch Transmural Protocol TIA/CVA’ (the LTA) to improve survival, minimize the risk of stroke recurrence, and increase quality of life after stroke. This study examines whether survival improved after implementation of the new protocol, and whether there was an increase in contacts with the general practitioner (GP)/nurse practitioner, registration of comorbidity and prescription of medication.MethodsFrom the primary care database of the Registration Network Groningen (RNG) two cohorts were composed: one cohort compiled before and one after introduction of the LTA. Cohort 1 (n = 131, first stroke 2001–2002) was compared with cohort 2 (n = 132, first stroke 2005–2006) with regard to survival and the secondary outcomes.ResultsComparison of the two cohorts showed no significant improvement in survival. In cohort 2, the number of contacts with the GP was significantly lower and with the nurse practitioner significantly higher, compared with cohort 1. All risk factors for stroke were more prevalent in cohort 2, but were only significant for hypercholesterolemia. In both cohorts more medication was prescribed after stroke, whereas ACE inhibitors were prescribed more frequently only in cohort 2.ConclusionNo major changes in survival and secondary outcomes were apparent after introduction of the LTA. Although, there was a small improvement in secondary prevention, this study shows that optimal treatment after introduction of the LTA has not yet been achieved.

Impact of postoperative transient ischemic attack on survival after carotid revascularization

“…Although of different origin, the TIA effect on long-term mortality is similar in the general population and in patients submitted to carotid revascularization: as a matter of fact, the 78% 5-year survival of our study compares well with the 58% to 87% of the cohort studies in the general population. 22,23 Therefore, TIA can be considered an indicator of clinical impairment independent of its pathogenesis, as confirmed from our analysis in which, before surgery, symptomatic patients had similar long-term mortality rate regardless of the onset of other postoperative events.…”

“…22 Similarly, the Dutch TIA Trial showed 60% mortality at 10 years in patients who had a TIA. 23 There is a variety of possible TIA causes in the general populationdsuch as cardiac rhythm alteration or great vessels atherosclerosisdthat can be a cause of late death; differently, TIAs after carotid revascularization are primarily associated with intraprocedural or periprocedural embolization. The majority of TIAs, in our study, occurred in the CAS group.…”

Stroke follow-up in primary care: a prospective cohort study on guideline adherence

“…As an example, lifestyle advice was offered to only one in four patients [ 14 ]. After the introduction of the Dutch protocol, only minimal impact was noted on clinical practice and no major changes in survival or secondary outcomes were found [ 15 ].…”